Professional Ethics & Standards Flashcards
7 cards from real CAC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Professional Ethics & Standards flashcards as text
Which of the following scenarios represents a potential HIPAA breach in an EMS billing context?
Answer: Discussing a patient's billing dispute in a public waiting room where others can overhear
Discussing PHI in a public area where unauthorized individuals can hear it constitutes an improper disclosure under HIPAA.
A coder is asked to backdate a claim to avoid a filing deadline. This action would constitute:
Answer: Fraud
Intentionally falsifying dates on a claim to meet filing deadlines is fraud and violates the False Claims Act if submitted to a federal payer.
What does CERT stand for in relation to Medicare claim audits?
Answer: Comprehensive Error Rate Testing
CERT (Comprehensive Error Rate Testing) is a CMS program that measures improper payment rates for Medicare fee-for-service claims.
Which of the following best describes the ethical concept of 'non-maleficence' as it applies to an EMS coder?
Answer: Avoiding coding practices that could harm the agency, patients, or payers
Non-maleficence in coding means avoiding actions — such as upcoding or fraud — that could harm patients, payers, or the organization.
When is a Physician Certification Statement (PCS) required for Medicare ambulance transport?
Answer: For scheduled, non-emergency transports to or from a physician's office
A PCS is required for Medicare to pay for scheduled (non-emergency) ambulance transports, certifying that the transport is medically necessary.
What is the primary purpose of a coding audit in an EMS agency?
Answer: To verify that coding practices are accurate, compliant, and supported by documentation
Coding audits assess accuracy and compliance, identifying errors that could represent overpayments, underpayments, or fraud risk.
If an EMS agency self-identifies a billing error that resulted in overpayment from Medicare, what is the ethical and legal obligation?
Answer: Report and return the overpayment within 60 days of identification
The Affordable Care Act requires that known Medicare overpayments be reported and returned within 60 days of identification to avoid False Claims Act liability.